Breast cancer Flashcards
History of the patient with suspected breast cancer
onset/duration of menarche pregnancies parity artificial/natural menopause LMP previous breast lesions/biopsies hormone supplimentation radiation exposure FHx breast cancer Back/bone pain systemic/weight loss
Most frequent sites of metastasis
Bones, liver, lungs
most significant prognostic feature
lymph node involvement
Characteristics of palpable breast mass
Painless
Less frequent: pain, nipple discharge, erosion, retraction, enlargement, or itching of the nipple, redness, generalized hardness, shrinking of the breast.
Characteristics of tumor
non tender, firm or hard lump
poorly delineated margins d/t local infiltration
Slight skin or nipple retraction
1-2mm erosions of nipple epithelium–Paget’s carcinoma
Watery, serous, or bloody nipple discharge–but is more often a benign sign.
If there is a questionable mass
The patient should return after her period
Characteristics of advanced carcinoma
edema redness nodularity or ulceration presence of a large primary tumor (>5cm) fixation to the chest wall enlargement shrinkage retraction marked axillary lymphadenopathy edema of ipsilateral arm supraclavicular lymphadenopathy distant mets
Axillary lymph nodes receive how much drainage from the breast
> 85%
Axillary nodes that are matted or fixed to skin or deep structures indicate
Locally advanced disease (at least stage III)
Firm or hard nodes of any size in which area indicate locally advanced disease?
Supraclavicular and infraclavicular nodes
Biopsy or fine needle aspiration to confirm nodal involvement in these areas is paramount.
eczematoid eruption and ulceration that arises from the nipple, can spread to the areola, and is associated with an underlying carcinoma.
PAGET’S DISEASE OF THE BREAST (1% of all breast cancers)
Pain, itching, and/or burning are often the presenting symptoms, along with a superficial erosion or ulceration. Less frequently, a bloody discharge and nipple retraction are observed. The diagnosis is established most often by full-thickness biopsy of the lesion, which reveals the pathognomonic intraepithelial adenocarcinoma cells or Paget cells within the epidermis of the nipple. In 12–15% of patients with Paget’s disease of the breast, no associated underlying intraparenchymal breast cancer is found.
diffuse, brawny edema of the skin of the breast with an erysipeloid border, usually without an underlying palpable mass
Inflammatory carcinoma
What causes the inflammation in inflammatory breast cancer
The inflammatory component, often mistaken for an infectious process, is caused by the blockage of dermal lymphatics by tumor emboli, which results in lymphedema and hyperemia. If a suspected skin infection does not rapidly respond (1–2 weeks) to a course of antibiotics, biopsy must be performed.
What is the treatment of choice in breast cancer diagnosed during pregnancy
In most instances, modified radical mastectomy in pregnancy is the minimal treatment of choice, with the possible exception of the latter part of the third trimester, wherein breast-conservation therapy followed by postpartum radiotherapy may be considered. Most women with breast cancer diagnosed during pregnancy or lactation will be candidates for systemic chemotherapy.
Risk of fetal teratogenicity is highest during
first trimester and period of organogenesis
